P0687 - Alcoholic Hepatitis: A Nationwide Study on the Trends of 30-Day Readmissions from 2010 to 2018

Dushyant S. Dahiya, MD¹, Asim Kichloo, MD¹, Farah Wani, MD², Katayoun Khoshbin, MD³, Hafeez Shaka, MD³, Mohammad Al-Haddad, MD^4
1Central Michigan University College of Medicine, Saginaw, MI; ²Samaritan Medical Center, Watertown, NY; ³John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ⁴Indiana University, Indianapolis, IN

Introduction: Alcoholic Hepatitis (AH) is associated with readmissions secondary to continued alcohol use post discharge. We aimed to identify the biodemographic characteristics, readmission trends and outcomes associated with 30-day readmissions for AH.



Methods: This retrospective interrupted trend study analyzed the National Readmission Database (NRD) for the years 2010, 2012, 2014, 2016, and 2018 to identify readmissions within 30-days of index admissions for AH using ICD-9-CM and ICD-10-CM codes. Patients < 18 years, elective and traumatic readmissions were excluded. Multivariate regression analysis was used to calculate the trends for risk-adjusted odds of all-cause 30-day readmissions, AH specific readmissions, mortality, hospital stay and cost after adjusting for age, gender, Charlson Comorbidity Index, insurance type, mean household income, and hospital characteristics.

Results: The total number of readmissions within 30-days following index hospitalization for AH more than doubled from 1,839 in 2010 to 3,784 in 2018 (p-trend < 0.001). However, only metropolitan teaching hospitals noted a significant rising trend in readmissions (p-trend < 0.001). A male predominance was noted for readmissions; however, gender distribution was not statistically significant. AH readmissions had an increasing comorbidity burden with time (Table 1). Although the 30-day all-cause readmission rate increased from 18.8% in 2010 to 24.4% in 2018, no significant trend was noted on multivariate regression analysis. Furthermore, there was a significant risk-adjusted trend towards decreasing inpatient mortality from 8.7% in 2010 to 7.4% in 2018 for AH readmissions within 30 days (p = 0.022) (Table 1). Over the study period, the total days of hospital stay attributable to AH readmissions increased by 132.5% from 11,275 days in 2010 to 26,220 days in 2018 with total attributable hospital cost rising by 160.9% to over $67 million by 2018.

Discussion: From 2010–2018, the 30-day readmissions of AH trended upwards which may in part be attributed to sudden decompensation or continued alcohol use after discharge. However, the risk-adjusted inpatient mortality was on a decline reflecting significant improvement in management. Additionally, 30-day readmissions of AH places significant burden on the US healthcare system as the total days of hospital stay and attributable hospital costs increased by 132.5% and 160.7%, respectively.

VARIABLE	YEAR
	2010	2012	2014	2016	2018
Biodemographic Characteristics
Number of Readmissions	1,839	2,227	2,716	3,503	3,784
Mean age (year)	46.8 ± 0.9	46.4 ± 0.8	46.4 ± 0.7	45.9 ± 0.6	46.1 ± 0.5
Males (%)	58.1	53.4	57.2	56.7	54.4
Charlson Comorbidity Index score (%)
0	23.3	23.6	21.5	5.4	5.6
1	24.6	23.5	18.0	26.8	27.0
2	6.3	5.8	6.7	10.0	10.1
≥3	45.8	47.1	53.8	57.8	57.3
Insurance Type (%)
Medicare	14.9	13.6	15.5	15.2	15.5
Medicaid	37.7	35.4	41.8	43.7	41.2
Private	29.2	33.3	29.3	29.8	30.6
Uninsured	18.2	17.7	13.4	11.3	12.7
Household Income Quartile (%)
$1–43,999	28.8	29.6	26.4	25.9	26.9
$44,000–55,999	23.7	24.5	27.6	26.7	27.5
$56,000–73,999	25.6	23.5	23.8	26.3	26.7
>$74,000	21.9	22.4	22.2	21.1	19.0
Hospital Bed Size (%)
Small	13.2	12.1	17.2	14.2	15.8
Medium	21.0	25.6	28.3	27.3	27.8
Large	65.8	62.3	54.5	58.5	56.4
Hospital Teaching Status (%)
Metropolitan non-teaching	42.3	34.4	23.0	24.5	19.4
Metropolitan teaching	50.3	57.1	72.0	70.1	75.1
Non-metropolitan	7.4	8.5	5.0	5.4	5.5
Hospital Volume Quintiles (%)
Q1	5.2	3.1	4.7	3.1	3.5
Q2	6.2	6.9	5.6	7.3	7.6
Q3	10.8	12.7	11.5	11.3	10.9
Q4	20.3	19.8	19.9	21.0	20.4
Q5	57.5	57.5	58.3	57.3	57.6
Outcomes
All Cause Readmission Rate (%) (p-trend=0.107)	18.8	19.9	21.3	25.9	24.4
Alcoholic Hepatitis Specific Readmission Rate (%) (p-trend=0.546)	2.9	3.0	2.9	3.7	3.9
Alcoholic Hepatitis Readmission Proportion (%) (p-trend=0.402)	18.6	18.0	16.6	18.1	20.0
Inpatient Mortality (%) (p-trend=0.022)	8.7	8.5	8.5	9.1	7.4
Mean Length of Stay (days) (p-trend=0.822)	6.1	6.0	6.1	6.7	6.7
Mean Total Hospital Cost (USD) (p-trend=0.306)	14,285	12,952	13,331	16,456	17,227

Table: Table 1: Biodemographic characteristics, readmission trends and outcomes for 30-day readmissions of Alcoholic Hepatitis.


Disclosures:
Dushyant Dahiya indicated no relevant financial relationships.
Asim Kichloo indicated no relevant financial relationships.
Farah Wani indicated no relevant financial relationships.
Katayoun Khoshbin indicated no relevant financial relationships.
Hafeez Shaka indicated no relevant financial relationships.
Mohammad Al-Haddad indicated no relevant financial relationships.


Dushyant S. Dahiya, MD¹, Asim Kichloo, MD¹, Farah Wani, MD², Katayoun Khoshbin, MD³, Hafeez Shaka, MD³, Mohammad Al-Haddad, MD⁴. P0687 - Alcoholic Hepatitis: A Nationwide Study on the Trends of 30-Day Readmissions from 2010 to 2018, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.